Provider Demographics
NPI:1184176620
Name:GARY FORREST COX MD PA
Entity type:Organization
Organization Name:GARY FORREST COX MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-579-4705
Mailing Address - Street 1:2705 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5775
Mailing Address - Country:US
Mailing Address - Phone:361-579-4705
Mailing Address - Fax:361-579-4755
Practice Address - Street 1:2705 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5775
Practice Address - Country:US
Practice Address - Phone:361-579-4705
Practice Address - Fax:361-579-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4273207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034183601Medicaid
TX034183601Medicaid